Healthcare Provider Details

I. General information

NPI: 1861521866
Provider Name (Legal Business Name): VOLUNTEERS OF AMERICA NORTHERN ROCKIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 N 15TH ST
LARAMIE WY
82072-2343
US

IV. Provider business mailing address

PO BOX 1005
CHEYENNE WY
82003-1005
US

V. Phone/Fax

Practice location:
  • Phone: 307-745-8915
  • Fax:
Mailing address:
  • Phone: 307-426-4727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KELLY BUCKINGHAM
Title or Position: VP IF IT AND COMPLIANCE
Credential:
Phone: 307-672-0475